Surgical retractors of various configurations are known in the art. Representative is a surgical retractor sold by Genesee Biomedical, Inc. under the trademark SRC-AR™ and which is described in Wright, U.S. Pat. No. 5,772,853, the contents of which are incorporated by reference in their entirety herein. Other examples of surgical retractors include the Genzyme-OPCAB Elite™ system sold by Genzyme Surgical Products Corporation; the Medtronic Octobase™ retractor system sold by Medtronic, Inc. and the Guidant Acrobat™ off-pump system retractor sold by Guidant Corporation.
Each of the Genzyme-OPCAB Elite™ system, the Medtronic Octobase™ retractor system and the Guidant Acrobat™ retractor system include integral suture retainers. These retractors are of particular utility in off-pump coronary artery bypass surgery. During off-pump, beating heart coronary artery, bypass surgery it is advantageous to place the patient in a steep Trendlenburg position and to elevate the apex of the left ventricle. To achieve elevation of the apex of the heart a series of surgical sutures are placed around the posterior wall of the pericardium. Typically, the sutures are made of silk or a monofilament size 2, 1 or 0. In order to maintain the apex of the heart in the desired position, the sutures must be secured to a suitable fixture such as the arms of a retractor. Thus, each of the Genzyme-OPCAB Elite™ system, the Medtronic Octobase™ retractor system and the Guidant Acrobat™ retractor system include suture retainers spaced lengthwise of the retractor arms. Ideally these suture retainers assist not only in fastening the sutures to the retractor arms to maintain the apex the heart in the desired elevated position, but also function to organize the sutures to assist in speeding the surgical procedure.
The Genzyme-OPCAB Elite™ system has channels for receiving sutures, but requires locking forceps to be used in conjunction with the channels to hold the sutures in a select position. Use of these locking forceps can complicate the surgical procedure, requires introduction of additional apparatus into an already crowded operating field and increases the time to complete a procedure by requiring manipulation of numerous locking forceps.
Both the Medtronic Octobase™ and the Guidant Acrobat™ retractors offer improvement to the Genzyme-OPCAB Elite™ system by providing self-locking suture retainers as integral elements with the surgical retractor arm for both organizing and grasping surgical sutures. In each instance the suture retainers include a cam element operatively associated with a suture channel. The cam element pivots to grasp and retain the suture within the suture channel to prevent axial withdrawal of the suture from the suture channel. While these cammed suture retainer structures offer a clear advantage over the use of locking forceps in systems like the Genzyme-OPCAB Elite™ system, use of the mechanical cam system presents some serious problems. First, these devices are disposable and relatively expensive (reusable devices would be very difficult to clean and the locking cams could be locked in a non-gripping position by dried blood or debris generated in a surgical procedure and thus rendered inoperative). In addition, the prior art locking cams have many small components that potentially might become detached and fall into the patient's chest cavity.
The present invention is directed towards overcoming one or more of the problems discussed above.